Diabetic gastroparesis

Last updated: September 11, 2023

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Summarytoggle arrow icon

Diabetic gastroparesis is a complication of long-term diabetes characterized by delayed gastric emptying that is not associated with mechanical obstruction. Risk factors are inadequate glycemic control and obesity. Symptoms typically include nausea, vomiting, abdominal discomfort, and early satiety. Diabetic gastroparesis is a diagnosis of exclusion and is confirmed by scintigraphic gastric emptying. The mainstay of treatment is conservative management with glycemic control, dietary modifications, and avoidance of medications and substances that delay gastric emptying. Prokinetic agents may improve gastric emptying, whereas antiemetics can provide symptom relief. Patients with refractory symptoms may require surgery, gastric electric stimulation, or parenteral feeding.

See also “Diabetic neuropathy.”

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Risk factorstoggle arrow icon

Pathophysiologytoggle arrow icon

Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon

Approach [3][4][9]

Laboratory studies [3]

Confirmatory tests [4]

At least 48 hours prior to confirmatory testing, stop medications that affect gastric emptying, and initiate strict glucose control to prevent false negative or false positive results. [4]

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Managementtoggle arrow icon

Approach [4][9]

Pharmacotherapy should be offered as a short-term treatment for diabetic gastroparesis; long-term use of medications is associated with adverse effects. [4]

Nonpharmacological management [4]

Some medications used to treat diabetes (e.g., GLP-1 agonists, pramlintide) can delay gastric emptying. Consider alternative agents in patients with diabetic gastroparesis. [7]


Prokinetics [4]

Antiemetics [4]

Central neuromodulators (e.g., haloperidol, nortriptyline) are not recommended at present because of a lack of evidence. [4]

Management of refractory diabetic gastroparesis

Surgery [4]

Intrapyloric botulinum toxin injections have been trialed in the past but are not currently recommended due to a lack of efficacy. [4]

Gastric electric stimulation (GES)

  • Provides high-frequency electrical pulses to the stomach through leads that are implanted into the stomach wall to enhance gastric emptying [19]
  • Evidence to support its use has been mixed. [4][20]

Parenteral nutrition [4]

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Young CF, Moussa M, Shubrook JH. Diabetic Gastroparesis: A Review. Diabetes Spectr. 2020; 33 (3): p.290-297.doi: 10.2337/ds19-0062 . | Open in Read by QxMD
  2. Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2016; 40 (1): p.136-154.doi: 10.2337/dc16-2042 . | Open in Read by QxMD
  3. Camilleri M, Kuo B, Nguyen L, et al. ACG Clinical Guideline: Gastroparesis. Am J Gastroenterol. 2022; 117 (8): p.1197-1220.doi: 10.14309/ajg.0000000000001874 . | Open in Read by QxMD
  4. Schol J, Wauters L, Dickman R, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J. 2021; 9 (3): p.287-306.doi: 10.1002/ueg2.12060 . | Open in Read by QxMD
  5. Careyva B, Stello B. Diabetes Mellitus: Management of Gastrointestinal Complications. Am Fam Physician. 2016; 94 (12): p.980-986.
  6. Camilleri M, Dilmaghani S, Vosoughi K, Zheng T. A North American perspective on the ESNM consensus statement on gastroparesis. Neurogastroenterol Motil. 2021; 33 (8).doi: 10.1111/nmo.14174 . | Open in Read by QxMD
  7. Sharma A, Coles M, Parkman HP. Gastroparesis in the 2020s: New Treatments, New Paradigms. Curr Gastroenterol Rep. 2020; 22 (5).doi: 10.1007/s11894-020-00761-7 . | Open in Read by QxMD
  8. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000; 95 (6): p.1456-1462.doi: 10.1111/j.1572-0241.2000.02076.x . | Open in Read by QxMD
  9. O’Grady J, Murphy CL, Barry L, Shanahan F, Buckley M. Defining gastrointestinal transit time using video capsule endoscopy: a study of healthy subjects. Endosc Int Open. 2020; 08 (03): p.E396-E400.doi: 10.1055/a-1073-7653 . | Open in Read by QxMD
  10. Camilleri M. Diabetic Gastroparesis. N Engl J Med. 2007; 356 (8): p.820-829.doi: 10.1056/nejmcp062614 . | Open in Read by QxMD
  11. Choung RS, Locke RG, Schleck CD, Zinsmeister AR, Melton JL, Talley NJ. Risk of Gastroparesis in Subjects With Type 1 and 2 Diabetes in the General Population. Am J Gastroenterol. 2012; 107 (1): p.82-88.doi: 10.1038/ajg.2011.310 . | Open in Read by QxMD
  12. Bytzer P, Talley NJ, Hammer J, Young LJ, Jones MP, Horowitz M. GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol. 2002; 97 (3): p.604-611.doi: 10.1111/j.1572-0241.2002.05537.x . | Open in Read by QxMD
  13. Olausson EA, Störsrud S, Grundin H, Isaksson M, Attvall S, Simrén M. A Small Particle Size Diet Reduces Upper Gastrointestinal Symptoms in Patients With Diabetic Gastroparesis: A Randomized Controlled Trial. Am J Gastroenterol. 2014; 109 (3): p.375-385.doi: 10.1038/ajg.2013.453 . | Open in Read by QxMD
  14. Camilleri M. Cannabinoids and gastrointestinal motility: Pharmacology, clinical effects, and potential therapeutics in humans. Neurogastroenterol Motil. 2018; 30 (9): p.e13370.doi: 10.1111/nmo.13370 . | Open in Read by QxMD
  15. Grad S, Abenavoli L, L. Dumitrascu D. The Effect of Alcohol on Gastrointestinal Motility. Rev Recent Clin Trials. 2016; 11 (3): p.191-195.doi: 10.2174/1574887111666160815103251 . | Open in Read by QxMD
  16. Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther. 2009; 31 (1): p.11-19.doi: 10.1111/j.1365-2036.2009.04189.x . | Open in Read by QxMD
  17. Parsi MA, Jirapinyo P, Abu Dayyeh BK, et al. Techniques and devices for the endoscopic treatment of gastroparesis. Gastrointest Endosc. 2020; 92 (3): p.483-491.doi: 10.1016/j.gie.2020.03.3857 . | Open in Read by QxMD
  18. Alicuben ET, Samaan JS, Houghton CC, Soffer E, Lipham JC, Samakar K. Sleeve Gastrectomy as a Novel Procedure for Gastroparesis. Am Surg. 2020; 87 (8): p.1287-1291.doi: 10.1177/0003134820979781 . | Open in Read by QxMD
  19. Sarosiek I, Davis B, Eichler E, McCallum RW. Surgical Approaches to Treatment of Gastroparesis. Gastroenterol Clin North Am. 2015; 44 (1): p.151-167.doi: 10.1016/j.gtc.2014.11.012 . | Open in Read by QxMD
  20. Van Norman GA. Expanded Patient Access to Investigational New Devices: Review of Emergency and Nonemergency Expanded Use, Custom, and 3D-Printed Devices. JACC Basic Transl Sci. 2018; 3 (4): p.533-544.doi: 10.1016/j.jacbts.2018.06.006 . | Open in Read by QxMD
  21. $Contributor Disclosures - Diabetic gastroparesis. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.

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